Validation of the short forms of the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in Finnish.

BACKGROUND: Although several validated generic health-related quality of life instruments exist, disease-specific instruments are important as they are often more sensitive to changes in symptom severity. It is essential to validate the instruments in a new population and language before their use. The objective of the study was to translate into Finnish the short forms of three condition-specific questionnaires (PFDI-20, PFIQ-7 and PISQ-12) and to evaluate their psychometric properties in Finnish women with symptomatic pelvic organ prolapse. METHODS: A multistep translation method was used followed by an evaluation of validity and reliability in prolapse patients. Convergent and discriminant validity, internal consistency and reliability via test-retest were calculated. RESULTS: Sixty-three patients waiting for prolapse surgery filled the three questionnaires within two weeks. Response rate for each item was high in PFDI-20 and PISQ-12 (99.8 and 98.9% respectively). For PFIQ-7 response rate was only 60%. In PFIQ-7, six respondents (9.5%) reached the minimum value of zero showing floor effect. None of the instruments had ceiling effect. Based on the item-total correlations both PFIQ-7 and PFDI-20 had acceptable convergent validity, while the convergent validity of PISQ-12 was lower, r = 0.138-0.711. However, in this instrument only three questions (questions 6, 10 and 11) had r < 0.3 while others had r ≥ 0.380. In the test-retest analysis all the three instruments showed good reliability (ICC 0.75-0.92). Similarly, the internal consistency of the instruments, measured by Cronbach's α, was good (range 0.69-0.96) indicating high homogeneity. CONCLUSIONS: Finnish validated translation of the PFDI-20 and PISQ-12 have acceptable psychometric properties and can be used for both research purposes and clinical evaluation of pelvic organ prolapse symptoms. The Finnish version of PFIQ-7 displayed low response rate and some evidence of a floor effect, and thus its use is not recommended in its current form.

Robotic-assisted laparoscopy is a feasible method for resection of deep infiltrating endometriosis, especially in the rectosigmoid area.

OBJECTIVE: This study aimed to compare outcomes of mini-invasive surgical treatment of endometriosis, especially conventional laparoscopy with robotic-assisted laparoscopy, and to evaluate the quality of life. METHODS: One hundred three consecutive patients with endometriosis who had surgery from 2014 to 2017 owing to an indication of pain were enrolled in this retrospective study. The majority (n = 77, 75%) of patients underwent conventional laparoscopy and 18 (17%) had robotic-assisted laparoscopy. The quality of life was postoperatively assessed with a questionnaire. RESULTS: The rates of parametrectomy (76% vs. 45%,) and rectovaginal resection (28% vs. 4%) were significantly higher in robotic-assisted laparoscopy than in laparoscopy. Additionally, the rate of bowel operations (50% vs. 17%), especially the shaving technique, was higher in robotic-assisted laparoscopy surgery than in laparoscopy (39% vs. 8%). There was no difference in the rate of postoperative complications between laparoscopy and robotic-assisted laparoscopy. Most (91%) of the patients who answered the questionnaire felt that surgical treatment had relieved their pain. In the laparoscopic and robotic-assisted groups, 88% of respondents felt that their quality of life had improved after surgery. CONCLUSIONS: This study suggests that robotic-assisted laparoscopy is a feasible method to resect deep infiltrating endometriosis, especially in the rectosigmoid area.

Downregulated CD44 and hyaluronan expression in vulvar intraepithelial neoplasia and squamous cell carcinomas.

OBJECTIVE: To investigate the expression of CD44 and hyaluronan in vulvar squamous cell carcinomas, vulvar intraepithelial neoplasia (VIN) and lichen sclerosus (LS) cases. DESIGN: Retrospective study. SETTING: Kuopio University Hospital in Finland. SAMPLES AND METHODS: A total of 18 vulvar squamous cell carcinomas, 22 VIN and 14 LS cases were studied by immunohistochemistry and histochemistry. Co-localization of these markers was also studied by dual fluorescence staining. MAIN OUTCOME MEASURES: Expression and cellular localization of CD44 and hyaluronan. RESULTS. In the normal squamous cell epithelium and in most LS samples, CD44 and hyaluronan were expressed homogeneously along plasma membranes with extensive co-localization. In carcinomas and VIN, both CD44 and hyaluronan were mostly irregular and without co-localization. In most VIN samples, CD44 was membranous, while hyaluronan was intracellular in 45% of the cases. CD44 showed both plasma membrane and intracellular localization in 39% of the carcinomas and in 94% of the cases hyaluronan was located only intracellularly. In LS, stromal hyaluronan staining was stronger than in carcinomas (p = 0.01). CD44 and hyaluronan staining was not associated with the grade of VIN, while there was good differentiation in carcinomas associated with preserved membranous CD44 (p = 0.012). Hyaluronan was not associated with the grade or stage of cancer. CONCLUSIONS: Differences in hyaluronan and CD44 expression in VIN and squamous cell carcinomas compared to normal epithelium suggest that they have a role in vulvar malignancy.

Multidrug resistance 3 gene mutation 1712delT and estrogen receptor alpha gene polymorphisms in Finnish women with obstetric cholestasis.

OBJECTIVE: To investigate the contribution of the estrogen receptor alpha (ERalpha) polymorphism in the development of obstetric cholestasis and to determine whether multidrug resistance 3 (MDR3) gene 1712delT mutation detected in French patients is also present in Finnish women with obstetric cholestasis. STUDY DESIGN: In a retrospective case-control study, two ERalpha polymorphisms and MDR3 gene mutation 1712delT were investigated in healthy control women (N=47) and in women with diagnosis of obstetric cholestasis (N=57). PvuII and XbaI polymorphisms in ERalpha gene were evaluated in genomic DNA by using the polymerase chain reaction (PCR). In addition, the frequencies in the general population in our area are presented for comparison. RESULTS: None of the ERalpha genotypes or alleles was significantly over-represented in obstetric cholestasis. When the two ERalpha gene polymorphisms were analyzed in parallel, six genotype combinations were recognized, and the distribution of these genotype combinations did not reveal statistically significant differences between the cases and controls (P=0.612). No patient or control was heterozygous or homozygous for the mutant allele in the MDR3 gene. CONCLUSION: The present data indicate that polymorphism of the ERalpha and MDR3 genes 1712delT mutation are unlikely to play any significant role in obstetric cholestasis in affected Finnish women. Further work to identify explanatory factors is of particular interest.